LGBT Health Care Experiences

We appreciate your willingness to complete this short survey to help us better understand and improve the healthcare experiences and cancer awareness of the LGBTQI population in California. To be eligible to take the survey, you need to be 18 years of age or older, self-identified as LGBTQI and living in California. The survey should take about 5-10 minutes to complete. Please answer every question. You may opt out of the survey at any time. We greatly appreciate your participation.

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1.Which category below includes your age?

18-20

21-29

30-39

40-49

50-59

60 or older

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2.What is your self-asserted gender expression?

Male

Female

Trans Male to female

Trans Female to Male

Genderqueer

Decline to Answer

Other (please specify)

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3.What is your biological gender?

Male

Female

Decline to Answer

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4.With what ethnicity/race do you identify?

Latino/Hispanic

Asian American

Black or African American

Caucasian or white

Native Hawaiian or Other Pacific Islander

American Indian or Alaska Native

Multiracial

Other (please specify)

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5.What was the highest grade or year of school you completed?

Never attended school

Elementary School (6th grade) or less

Some high school

High school diploma

Trade or Vocational School

Some college

College degree at bachelor's level

Some postgraduate work

Master’s Degree (M.S., M.A., MBA, etc.)

Doctoral Degree (Ph.D., L.L.D., M.D., etc.)

Other (please specify)

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6.Would you prefer that your sexual orientation and gender expression be included in your medical record?